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DIY Injectables Are Trending—Here's Why That's a Problem · Aesthetics Unscripted

0:03
SPEAKER_00: Welcome to Aesthetics Unscripted.
0:05
SPEAKER_00: I'm your host, Kim, your regenerative aesthetic and longevity specialist, and I'm so pleased to introduce to you the supernurse.
0:14
SPEAKER_00: She's also a professor and a national trainer for a major device company.
0:21
SPEAKER_00: Her name is Elaine Sudario.
0:23
SPEAKER_00: And Elaine, welcome aboard.
0:24
SPEAKER_00: Thank you for joining us today.
0:26
SPEAKER_00: Thank you for having me.
0:27
SPEAKER_00: I want to start out first for our viewers.
0:30
SPEAKER_00: Can you please explain for your professional license?
0:34
SPEAKER_00: You're a DNP, an FNP, and a BC.
0:37
SPEAKER_00: Can you please explain to us exactly what do those mean?
0:40
SPEAKER_01: First, I am a nurse.
0:42
SPEAKER_01: Before you become a DNP, you have to have your FNP or any kind of master's in nursing, which I did.
0:50
SPEAKER_01: So FNP stands for family nurse practitioner, meaning you can be a provider from age like one to over a hundred years old.
0:59
SPEAKER_01: So you cover all the ages.
1:01
SPEAKER_01: And then after you I gained my master's degree, I went for my doctorate, which then you are at the terminal layer of your career.
1:11
SPEAKER_01: And that's for a doctor of nursing practice, which I actually focused on research and clinical practice.
1:19
SPEAKER_01: And BC is actually board certified.
1:22
SPEAKER_01: I have to be certified through um national certification in the United States to be called board certified.
1:30
SPEAKER_00: That's fantastic.
1:30
SPEAKER_00: And I know that's no joke.
1:32
SPEAKER_00: That's not an easy process.
1:33
SPEAKER_00: Something you should definitely be proud of.
1:35
SPEAKER_00: You've gone a long way with your education and then continuing to push your career nonstop.
1:40
SPEAKER_01: Thank you.
1:42
SPEAKER_01: I love education.
1:44
SPEAKER_00: So when it comes to being a professor and a provider, um, do you split your passions between the two?
1:49
SPEAKER_00: Do you lean a little bit more towards one or the other?
1:52
SPEAKER_00: Like, let's let's let the viewers see who you are.
1:55
SPEAKER_01: I actually do it all.
1:56
SPEAKER_01: Like I think they go hand in hand.
1:59
SPEAKER_01: As a clinician, I'm actually a pediatric hospitalist.
2:03
SPEAKER_01: That's kind of like my major job, too.
2:05
SPEAKER_01: I work in a hospital.
2:07
SPEAKER_01: As a pediatric hospitalist, I have a student with me almost every day to follow me as a preceptor.
2:15
SPEAKER_01: So I love teaching like the younger generation to become really safe and effective clinicians.
2:21
SPEAKER_01: Uh, they will be taking care of me one day.
2:23
SPEAKER_01: So I want to make sure they're um doing what's uh ethical and safe.
2:28
SPEAKER_01: So as far as our aesthetics practice, we have a training center, and I realized one day that all my students want to follow me around, and I see the gap in the industry where clinicians are not really taught the way they should, I feel like they should be taught.
2:45
SPEAKER_01: So I opened a training center for um clinicians who want to pursue aesthetics.
2:51
SPEAKER_00: I commend you on that because as a medical aesthetic educator, um, not tied with any one particular company like you are, you're with one of the huge national brands, but I do train private classes and work with different big box companies on a per diem basis.
3:08
SPEAKER_00: So I know the kind of pressure that you're under there, and also to maintain that career in the hospital and to be a provider yourself.
3:16
SPEAKER_00: On top of all this, I'm I'm just shocked and amazed.
3:19
SPEAKER_00: I love it.
3:20
SPEAKER_00: And uh I really think you're an inspiration for a lot of upcoming practitioners, be it whether they're aestheticians, nurses, or doctors.
3:28
SPEAKER_00: They should definitely take your advice.
3:31
SPEAKER_00: I love that you're all about continuing education in our industry.
3:35
SPEAKER_00: I agree with you.
3:36
SPEAKER_00: There's such a lack of, I feel like, respect for the idea that you got trained extensively, but two years from now, everything's going to be different.
3:45
SPEAKER_00: So therefore, you should keep up with your training.
3:48
SPEAKER_00: So many practitioners don't.
3:49
SPEAKER_01: Absolutely.
3:50
SPEAKER_01: I think that you have to be open to what's out there.
3:54
SPEAKER_01: There's always gonna be evidence-based like uh practices that are going to be like, you know, up to date with what's new and current.
4:04
SPEAKER_01: And I want our um providers in our spa to be that.
4:08
SPEAKER_01: And as a training center, I want to make sure I know everything that's out there because then I can, I don't have to be biased.
4:14
SPEAKER_01: I just state the facts, I present the facts, and I go with what really works because at the end of the day, it's really the outcome that I want to offer my patients.
4:24
SPEAKER_01: It's not about, like, you know, the profit.
4:26
SPEAKER_01: Profit is great, but I think that to truly care for your patients, I think you have to deliver outcome.
4:33
SPEAKER_00: So, for the newly graduated, no matter what age you are, if it's a second career or first career, please take Elaine's advice seriously that continuing education never stops.
4:44
SPEAKER_00: And you should be proud of yourself and continue to evolve your career so you can give the best patient care.
4:50
SPEAKER_00: Can you please let me know what is the name of your training center and where can they find you as a provider?
4:55
SPEAKER_01: Our med spa is called Vivesh Medspa.
4:57
SPEAKER_01: We are in 249 Main Street in Beacon, New York.
5:01
SPEAKER_01: We also have a clinic in Mayopac, New York, but our training center is tied to Vivesh Med Spa.
5:08
SPEAKER_01: It's called New York Aesthetics Consulting and Training.
5:11
SPEAKER_01: So we offer um training like once or twice a month, depending on like the need of the training per se for like the local, not even local, we have a lot of out-of-state uh clinicians who want to learn from us.
5:26
SPEAKER_01: So that's where we are.
5:27
SPEAKER_00: Let's talk about ketamine therapy in the med spa setting.
5:31
SPEAKER_00: I do see that you offer that service, and at your level of expertise, I can understand why you do.
5:38
SPEAKER_00: But can you please share with the viewers?
5:40
SPEAKER_00: And uh, I want to know what's your personal take on that?
5:44
SPEAKER_00: Like, why do you have ketamine therapy there?
5:46
SPEAKER_00: What kind of a clinic do you not want to go to?
5:50
SPEAKER_00: After you explain your clinic, what are the red flags for like don't just get this anywhere?
5:55
SPEAKER_01: Let's talk about what ketamine therapy is first, for those who are not familiar with it.
5:59
SPEAKER_01: So, ketamine therapy is a treatment that we use now for um mental health issues such as uh depression that is refractory to other medications.
6:13
SPEAKER_01: They've been on ear uh on it for years and it hasn't worked.
6:16
SPEAKER_01: So, ketamine therapy is a treatment that has that is uh evidence-based, clinical research has been done and it works for those uh populations, also helps with anxiety, uh PTSD, chronic pain, and we don't just take this lightly.
6:36
SPEAKER_01: So, mental health should be treated just like any kind of medical disease.
6:42
SPEAKER_01: So, therefore, the setting itself, although we offer it in our spa, is a combination of providing them a very relaxed space, it and the same time offer a medical service.
6:56
SPEAKER_01: So we're very serious about our treatment.
6:59
SPEAKER_01: We are very prepared, like uh we have code cards.
7:02
SPEAKER_01: So we are prepared in case there's like an emergency situation.
7:07
SPEAKER_01: We follow protocols, we have a medical director, so our medical director is um an anesthesiologist.
7:14
SPEAKER_01: So there's four providers, one MD who is an um anesthesiologist who is truly familiar with ketamine, because if you know ketamine in the hospital setting, we use that for pain therapy for procedures, and also it is an anesthetic medication.
7:35
SPEAKER_01: So having him on board makes us feel like we have somebody truly, truly familiar with the medication.
7:43
SPEAKER_01: We go through rigorous training, the four of us.
7:45
SPEAKER_01: There's there's two NPs on our end and an MD in our group.
7:50
SPEAKER_01: So we went through extensive training for a year, even before we opened this.
7:54
SPEAKER_01: It's not something we just take very lightly.
7:57
SPEAKER_01: We go through very thorough consultation.
8:00
SPEAKER_01: We talk to their providers, meaning their psychiatrist, their counselor.
8:04
SPEAKER_01: It's not just an infusion center.
8:07
SPEAKER_01: So if you are a patient who wants to get ketamine, you want to make sure that your private providers are certified, trained, you have a very safe protocol in place in the practice.
8:21
SPEAKER_00: Oh, I love that you pointed that out because that's so important.
8:24
SPEAKER_00: I think the biggest red flag is when you see, as you you just mentioned, it's just some random clinic that suddenly is advertising ketamine therapy, and they probably can't even answer your most of your questions adequately.
8:37
SPEAKER_00: I would definitely be afraid to go to a place like that.
8:40
SPEAKER_01: Absolutely.
8:41
SPEAKER_01: I want patients to really do the research.
8:43
SPEAKER_01: Like they have to research the providers, they have to read about me and the other three providers in the practice and make sure that you have informed consent what the procedure is like, what the risks, research benefits.
8:56
SPEAKER_01: Are you a good candidate?
8:58
SPEAKER_01: So it's not something we just say, okay, like you know, this is just another patient on the door.
9:03
SPEAKER_01: You are truly treated like a patient.
9:08
SPEAKER_01: Like we have to know your entire story, not just a number.
9:13
SPEAKER_00: Great.
9:14
SPEAKER_00: And for practitioners, I think that was also an invaluable insight that you and your medical team trained for a full year.
9:22
SPEAKER_00: That's in our line of work, that's extremely extensive and really in-depth.
9:28
SPEAKER_00: So I'm very impressed with that.
9:29
SPEAKER_00: I think it's important for practitioners that are contemplating doing this therapy to understand it's not an overnight education.
9:35
SPEAKER_01: No.
9:36
SPEAKER_01: And we are very strict on following protocol.
9:40
SPEAKER_01: Everyone has to be ACLS certified, BLS certified.
9:44
SPEAKER_01: We even require our uh front desk, our manager, everyone in the building to be certified just in case something happens.
9:51
SPEAKER_01: And during infusion, we require there are two providers just so if something happens.
9:57
SPEAKER_01: So everything like the dosing, it's very safe, but you just never know when things can go wrong, and you have to be prepared for that.
10:05
SPEAKER_00: So that leads me into my question about HRT therapy and the conversation that women are not getting.
10:11
SPEAKER_00: Um, we all know there was a lot of shock and awe around like, hey, HRT is great for you, but then almost instantaneously, hey, HRT is going to give you cancer.
10:20
SPEAKER_00: So there's all this conflicting information for women.
10:24
SPEAKER_00: Should you do it?
10:25
SPEAKER_00: Should you not do it?
10:26
SPEAKER_00: There's bioidentical HRT, right?
10:28
SPEAKER_00: Bioidentical hormone replacement therapy, then there's regular hormone replacement therapy.
10:33
SPEAKER_00: What can you share with us about the positives and the negatives from a real insight on um real-time experience with your patients?
10:42
SPEAKER_01: All right.
10:43
SPEAKER_01: So HRT is now almost like a trend.
10:46
SPEAKER_01: Everybody gets it now.
10:48
SPEAKER_01: Where at some point in time, no one talks about it.
10:52
SPEAKER_01: Right.
10:52
SPEAKER_01: Right?
10:52
SPEAKER_01: So HRT, I think at some point the providers, like even medical community, just stopped using it like overnight.
11:00
SPEAKER_01: I think it goes back in the early 2000s.
11:04
SPEAKER_01: Like uh it stems from that initiative.
11:06
SPEAKER_01: It's a study, the Women's Health Initiative, where it just talks about, you know, it can cause cancer, it can cause like clots, cardiovascular risk, and all that.
11:17
SPEAKER_01: And all of a sudden, like the prescription just plummeted overnight.
11:21
SPEAKER_01: And it was never talked again.
11:24
SPEAKER_01: And honestly, even in medical school, if you're a primary provider, it's something that is not really highlighted.
11:31
SPEAKER_01: Like menopause is not even like talked about so much unless you are in women's health, like you're really going through this like specialty, but no one talks about it.
11:41
SPEAKER_01: And I think through the years, like there's more like newer studies that has shown promise that if done right, just like anything else, you have the proper screening and you have the proper patients.
11:56
SPEAKER_01: I think there's what you call timing hypothesis, where you actually find which one, like what patient, when do you start?
12:05
SPEAKER_01: So that women's health initiative actually what happened then is it always only studied on women who are 60 and above.
12:12
SPEAKER_01: What about all the women that are perimenopausal?
12:15
SPEAKER_01: That's really when you should really discuss it.
12:18
SPEAKER_01: And those are when symptoms start.
12:21
SPEAKER_01: And I think recent studies have used that and kind of are more open to what are the medications, like how much estrogen, what kind of estrogen, is it oral, is it um topical?
12:35
SPEAKER_01: And studies have also shown that using like a vaginal cream or just like a patch, that is more tolerable and safer.
12:42
SPEAKER_01: So I think every provider who wants to offer like hormone therapy should dive deeply into clinical studies and follow clinical guidelines.
12:53
SPEAKER_01: I don't think that we should shy away from it because it's truly helpful.
12:58
SPEAKER_01: Like if you address those um population that is pre-monopausal, just like have on a monopoly stage, you could really help them and the benefits outweigh the risks.
13:12
SPEAKER_01: And I think that considering the risks is also really a good practice because safety is always on top, and that means proper monitoring is essential.
13:22
SPEAKER_01: Like you just don't put them in something and then that's it.
13:25
SPEAKER_01: You have to monitor their levels, you have to have a baseline level before you start anybody on anything.
13:32
SPEAKER_00: Exactly, because we live in a society now where everybody wants this, and they think, oh, I can just go online and there's all these places that'll give me a prescription.
13:40
SPEAKER_00: I take a two-second intake with a doctor remotely, and sometimes the doctor's not even there.
13:45
SPEAKER_00: It's just a questionnaire that the doctor signs off on it, and then they want to get procedures done or get these medications, and then they want to like they freak out and call their lawyer if something goes wrong.
13:56
SPEAKER_00: But it's like that whole process is wrong from the beginning to the end.
14:00
SPEAKER_00: I agree with you.
14:00
SPEAKER_00: You need a proper intake with HRT.
14:03
SPEAKER_00: You're going to start with a blood test.
14:04
SPEAKER_00: Is that correct?
14:05
SPEAKER_00: Absolutely.
14:06
SPEAKER_01: So there's a thorough like questionnaire, like about your symptoms, about your medical health, like uh what are your risk factors?
14:15
SPEAKER_01: So we do get your levels before starting you on any anything.
14:18
SPEAKER_00: For hormone replacement therapy, I also want our viewers to understand that it's not just for menopause, it's not just for perimenopause, but there are the small faction of women that have reproductive issues and have had things like hysterectomies.
14:31
SPEAKER_00: So these are all women that also fall into that category, that they would want to um do a deep dive and unpack a lot of information when it comes to do they want to, uh is their doctor suggesting they should incorporate it?
14:45
SPEAKER_00: And um, is it a good idea for them in the end?
14:48
SPEAKER_00: How do you feel?
14:49
SPEAKER_01: So I would say that you should start off like really talking to experts like a GYN, a gynecologist, because then they could really get your history, even get like issues where it concerns like the overall anatomy, your uterus, your ovaries, all of that, before you can just go in a place where okay, I just want hormones.
15:12
SPEAKER_01: No, you might not need it.
15:14
SPEAKER_01: You know, you just don't want to be in the trend of everybody just because everybody's doing it.
15:19
SPEAKER_01: Is it a good thing?
15:20
SPEAKER_01: It is a good thing.
15:21
SPEAKER_01: Could it be not a good thing?
15:23
SPEAKER_01: Absolutely.
15:24
SPEAKER_01: If you overdo it, like if you have a uterus and you just dump yourself with uh progesterone, you're probably overdoing it.
15:33
SPEAKER_01: So it it that comes into play.
15:35
SPEAKER_01: Like, do you have ovaries?
15:37
SPEAKER_01: Do you have uterus?
15:39
SPEAKER_01: So that also comes into play as far as what hormones you need.
15:43
SPEAKER_00: I love that you said progesterone because I think um uh a misconception right now is also it's just estrogen levels.
15:49
SPEAKER_00: So people will try to self-medicate and not understand that, as you said, it should be a huge intake based on things like your blood test and your health history and your current physicality.
15:59
SPEAKER_00: And it's constantly monitored.
16:01
SPEAKER_00: You you like someone like yourself, Elaine, you're not going to be prescribing HRT and then never talk to this patient again.
16:07
SPEAKER_00: It's constant checkups with this person and checking their blood levels.
16:12
SPEAKER_01: And also as patients, we have to be accountable with our actions too.
16:16
SPEAKER_01: Where do you go to?
16:17
SPEAKER_01: Like, you know, um, do you go for like cheap?
16:20
SPEAKER_01: Like if that's what you do, that's what you do to yourself.
16:23
SPEAKER_01: You have you're responsible for that.
16:25
SPEAKER_01: I think that every single provider, as also with a patient, we have to be all accountable and responsible and be very educated as to the next actions.
16:37
SPEAKER_01: Like you can't just play around with your health.
16:39
SPEAKER_01: Once it's there, it's there.
16:40
SPEAKER_00: Absolutely.
16:41
SPEAKER_00: Amen to that.
16:42
SPEAKER_00: I want to circle back to your training of the next generation of injectors.
16:46
SPEAKER_00: So I know, as you said, you offer injectable training at Vivash Med Spa.
16:51
SPEAKER_00: Um, it means you're shaping the next wave of our providers and how they approach the craft.
16:58
SPEAKER_00: Unfortunately, in Manhattan, we see far too many doctors and nurses transitioning out of conventional medicine into cosmetic medicine and getting like a two-hour, no exaggeration, like a two-hour course.
17:13
SPEAKER_00: I've even seen a course in Manhattan that unfortunately I don't understand how.
17:17
SPEAKER_00: It hasn't been shut down yet.
17:18
SPEAKER_00: They don't even treat you on live patients.
17:20
SPEAKER_00: They give you a didactic and then they give you a mannequin head.
17:24
SPEAKER_00: And I don't mean a meaning, yes, I don't mean a mannequin head with like pink skin over the top where you could actually inject into it.
17:30
SPEAKER_00: But it's like it's a it's a tough yes.
17:35
SPEAKER_00: And I'm like, what am I looking at?
17:37
SPEAKER_00: Is this a joke?
17:38
SPEAKER_00: And it turned out to not be a joke.
17:40
SPEAKER_00: And I'm just stunned and dismayed.
17:43
SPEAKER_00: So um uh tell me about what your injecting classes are like and uh how you feel about, you know, where's your passion for this?
17:52
SPEAKER_00: Because I'm sure you want to weigh in on the people that think they can just overnight learn how to do Votox.
17:57
SPEAKER_00: Yes, yes, definitely.
17:58
SPEAKER_01: So what I saw lacking was when I have these NP students following me around when I was injecting and said, you know, I already have certain certifications.
18:10
SPEAKER_01: Like, oh, great, it's like, you know, can you inject?
18:13
SPEAKER_01: It's like, oh, I don't know.
18:14
SPEAKER_01: It's like I got out of that training not knowing what to do.
18:17
SPEAKER_01: Like, and then more of them came.
18:18
SPEAKER_01: It's like, what is this training?
18:20
SPEAKER_01: How much did you pay for it?
18:22
SPEAKER_01: Like, and then I realized later on they go to this class for a few hours, there's 50 of them.
18:28
SPEAKER_01: So there's eight of them in one uh model, and she said she was able to inject a real person, but only like this, because she has to share that face with another eight students.
18:40
SPEAKER_01: I was like, wow, it's like it that's has that has to change.
18:43
SPEAKER_01: Like I have to do something about it because if you're following me around, I'm gonna teach you the right way.
18:50
SPEAKER_01: So we want to set ourselves apart from all other training uh companies.
18:55
SPEAKER_01: So what we didn't do is we have a training.
18:59
SPEAKER_01: Let's just it's like a didactic is there, like you you can do didactic in one day, and then each student will have each patient.
19:08
SPEAKER_01: So we have basic, you know, training and we have advanced training.
19:12
SPEAKER_01: We always start you off with basic.
19:14
SPEAKER_01: We want to make sure you're comfortable.
19:16
SPEAKER_01: Right.
19:16
SPEAKER_01: But into that, you can't just say, These are the points that you can inject.
19:22
SPEAKER_01: We have to teach anatomy.
19:24
SPEAKER_01: What's really underneath your skin?
19:26
SPEAKER_01: So it has to be very thorough.
19:28
SPEAKER_01: Like you're not just a rubber or a meat there that you're injecting.
19:33
SPEAKER_01: What is like Botox or what is like other neurotoxins?
19:37
SPEAKER_01: What can it do?
19:38
SPEAKER_01: So you start out with like mechanism of action, like why are you doing that?
19:42
SPEAKER_01: And a whole lot of like um assessment and consultation, and when to say yes or no to patient.
19:48
SPEAKER_01: Like they might not need it.
19:50
SPEAKER_01: You can't just treat everyone who walks into your door.
19:53
SPEAKER_01: So the difference also is that not like having a one-on-one practice on a live person, and then we want you to come back, bring more patients to practice, and actually really hone in your skills.
20:09
SPEAKER_01: I can't just let you walk out the door and expect you to inject.
20:12
SPEAKER_01: You can't unless you already work in a med spa where you're just getting the basics, and then when you go back there, you have a mentor.
20:20
SPEAKER_01: Mentorship is huge for us.
20:23
SPEAKER_01: You have to have a mentor because when you go out there and you start injecting, something happens.
20:29
SPEAKER_01: Who do you call?
20:31
SPEAKER_01: Like, so we have that open line with our students where they can call us.
20:36
SPEAKER_01: Or we even offer, like, listen, if you have clients that you're not comfortable with, take photos, take videos, tell us like what your problems are or what you're uncomfortable with, and we walk you through it.
20:49
SPEAKER_00: It's just to me, it's shocking that I always feel like um, especially when it comes to filler, but definitely also with neurotoxin, it should be more than a few hours.
20:58
SPEAKER_00: And what you're describing, I think, is that should be an industry standard.
21:02
SPEAKER_01: I think it's a huge responsibility.
21:04
SPEAKER_01: A lot of clinicians think they can get out of like bedside nursing or whatever they're doing because they're not happy and just go into aesthetics because it's easy.
21:12
SPEAKER_01: Well, no, it's not.
21:14
SPEAKER_01: Exactly.
21:15
SPEAKER_00: And let's talk about the craziness, and I'm gonna call it craziness, with um some of the social media trends that actually push viewers to think that they can just go buy diabetic needles and bootleg Botox or bootleg neurotoxin from some God only knows who the supplier is, and then wildly, like blatantly inject themselves.
21:37
SPEAKER_00: I just don't even understand where that mentality comes from because not only do you have the education, not only are you training in didactic and training your students in the anatomy and training your students on how to and where and when to use each filler, each neurotoxin, of which there are many different brands, but it's also right down to how you hold the needle and the Angles of the needle.
22:01
SPEAKER_00: I'm just like shocked and dismayed over the fact that you know there are social media trends to say go inject yourself.
22:08
SPEAKER_00: You don't have to go to a professional.
22:10
SPEAKER_00: So I'd like to hear what you have to say about that.
22:13
SPEAKER_01: We're talking about almost like a DYI here.
22:16
SPEAKER_01: We can do this at home.
22:18
SPEAKER_01: And it's crazy.
22:19
SPEAKER_01: Everyone should know that this is a medical practice.
22:23
SPEAKER_01: You're injecting medication in your body that can have impact or consequence in your body.
22:30
SPEAKER_01: All right.
22:30
SPEAKER_01: So let's just say you're an adult and this is what you want to your body.
22:34
SPEAKER_01: Guess what?
22:34
SPEAKER_01: You're free to do that, but it is just not safe.
22:38
SPEAKER_01: But if you're ready to take that consequence, that's on you.
22:41
SPEAKER_01: Do not do it to other people.
22:44
SPEAKER_01: Right.
22:44
SPEAKER_01: Right.
22:45
SPEAKER_00: Exactly.
22:45
SPEAKER_00: Could you imagine?
22:46
SPEAKER_00: Like, oh, I just got some Botox online and I'm gonna call all my friends too.
22:50
SPEAKER_00: That's just that's a an ER emergency waiting to happen.
22:54
SPEAKER_01: I just want to also emphasize that these products that you can get online, to me, that's just mind-boggling.
23:02
SPEAKER_01: Like how you can just you have access to it.
23:05
SPEAKER_01: And we are a practice that we always go by the rules.
23:10
SPEAKER_01: I won't inject anything that the FDA said you can't inject.
23:14
SPEAKER_01: It's just not right.
23:15
SPEAKER_01: Like you have to follow laws because guess what?
23:18
SPEAKER_01: If something does happen, which it can happen, whatever that is, it will always go back to you.
23:23
SPEAKER_01: It's not even just that.
23:25
SPEAKER_01: Like, first of all, you're doing a disservice to your patient if something does happen.
23:29
SPEAKER_01: Second of all, you're just putting your practice and yourself to a place where you could be in a loss of situation because using a product that is not FDA approved and having that consequence is a felony.
23:48
SPEAKER_01: No, it's true.
23:49
SPEAKER_01: I mean, I I'm just so scared of that.
23:51
SPEAKER_01: So I followed by the rooks.
23:54
SPEAKER_00: Excellent.
23:55
SPEAKER_00: That's excellent.
23:55
SPEAKER_00: I agree.
23:56
SPEAKER_00: Because I think um some practitioners, especially newly graduated ones, don't understand.
24:02
SPEAKER_00: They don't they don't take it seriously enough, as you said, what the legal implications are, because they think, oh, everybody's doing things off label.
24:11
SPEAKER_00: You just have your patient sign off that it's off label.
24:13
SPEAKER_00: But the problem is if a side effect happens and you end up in court and it's off label, it's an automatic loss.
24:20
SPEAKER_00: Period.
24:21
SPEAKER_00: End of story.
24:22
SPEAKER_00: Do not pass go, like Monopoly, do not collect your$200.
24:25
SPEAKER_00: You're out.
24:26
SPEAKER_00: You just lost.
24:27
SPEAKER_00: So when you know, to be like a cowboy in the room, why?
24:31
SPEAKER_01: Yeah.
24:31
SPEAKER_00: It just doesn't make sense.
24:33
SPEAKER_01: I have a client yesterday who says, Oh, can you inject salmon sperm under my eyes?
24:38
SPEAKER_01: It's like, no.
24:41
SPEAKER_01: Yes, I love you.
24:43
SPEAKER_01: Oh my God.
24:44
SPEAKER_00: I'm gonna have to invite you back because I am so against the PDRN thing, and we have a huge episode coming up specifically about that.
24:52
SPEAKER_00: And I'm on your side.
24:53
SPEAKER_01: I have just it done.
24:54
SPEAKER_01: It's like, well, you can go back to that person because I'm not just doing it.
24:59
SPEAKER_01: Do you know that it's not FDA approved?
25:01
SPEAKER_01: It's like I have it here.
25:02
SPEAKER_01: It's like, well, it looks like it's like I said, here I have my PDRN in a syringe.
25:08
SPEAKER_01: It looks like an injectable, but guess what?
25:10
SPEAKER_01: I'm not injecting it.
25:11
SPEAKER_01: It's not tested, it's not like I'm not, I know everybody else is doing it.
25:15
SPEAKER_01: Might be great if you have a great outcome, but I'm just not doing it because I am your biggest fan now.
25:23
SPEAKER_01: I just don't do it.
25:24
SPEAKER_01: I just don't do shortcuts.
25:26
SPEAKER_01: It's not approved for a reason, right?
25:28
SPEAKER_01: Until it's approved, I'll do it all.
25:31
SPEAKER_01: Until then, I just stay in my lane again.
25:34
SPEAKER_00: Yeah, I love it.
25:35
SPEAKER_00: And that's the smartest, and you like you said, the most responsible thing for the patient, whether they like it or not.
25:40
SPEAKER_00: It's true.
25:41
SPEAKER_00: You brought up the fact about this may major education and respect for the injectables themselves, because side effects can, and unfortunately, even with the best injectors, they will happen.
25:52
SPEAKER_00: So let's talk about filler migration.
25:54
SPEAKER_00: Sure.
25:55
SPEAKER_00: Uh there uh, as you know, there's a lot of scientific evidence that's coming out now where they took x-rays and other scans of patients with thermal scans and whatnot, showing that even up to 10 years later, filler was present, even though it's not supposed to last that long, filler migrated.
26:14
SPEAKER_00: But there's a lot of shock and awe behind this um, this like shocking media blitz.
26:20
SPEAKER_00: So I personally, you know, being um the founder and the creator of Soma Cell, which we'll talk about later, am a little bit against facial filler when, but it depends on who is getting it, why they're getting it, who's giving it, which filler are they using, and why.
26:39
SPEAKER_00: All of that comes together when it makes sense, then I'm for it.
26:43
SPEAKER_00: But to just blatantly be like, oh, there's a trend out there and I want to get my cheese filled, I'm like, God, no, please don't.
26:49
SPEAKER_00: Um, I'm a fan of lip filler because, as you know better than I do, PRP in your lips all day long, you could do that once a week for the rest of your life.
26:57
SPEAKER_00: It's not going to um be able to correct asymmetry, right?
27:02
SPEAKER_00: It's about healthy skin and skin layers.
27:04
SPEAKER_00: It's not going to be about correcting asymmetry um or if someone wants a little bit of a plump.
27:10
SPEAKER_00: So uh let's go back though to filler migration, and I'd love to hear a little bit more about your take on that.
27:16
SPEAKER_01: All right.
27:16
SPEAKER_01: So filler migration does happen, but every injector who really knows what they're doing can minimize that risk or not have a risk at all by knowing the depth, the plane, like plane is very important, the kind of fillers that you're gonna use.
27:34
SPEAKER_01: If you are using fillers for lifting, you want something that's uh higher G prime, meaning it's a it's a solid, a more solid filler where it stays where it should be.
27:45
SPEAKER_01: One key of that that also is overdosing.
27:49
SPEAKER_01: So you put a lot, it's gonna migrate at some point.
27:53
SPEAKER_01: Or, you know, if you're lucky enough, that it won't.
27:56
SPEAKER_01: But migration happens because you're overdoing it, overfilling it, or not getting a good history and not knowing that there's already a filler right there.
28:05
SPEAKER_01: You don't have to put more in there.
28:08
SPEAKER_01: So it's all about balance, it's all about knowing the anatomy.
28:13
SPEAKER_01: Like with lips, like that's like a lot of migration happens.
28:17
SPEAKER_01: It goes above your the border, the lip border, because you're injecting right at the border.
28:21
SPEAKER_01: So it could easily migrate behind beyond that border.
28:25
SPEAKER_01: So you want to inject a little bit under the border because if it does migrate, then you're just right there at the border.
28:32
SPEAKER_00: That reminds me, I wanted to ask you about lip filler.
28:35
SPEAKER_00: So, like I said, I know there's nothing else out there when it comes to balancing asymmetry.
28:40
SPEAKER_00: So if someone has a thin lip and then their other lip is big, or if someone has thinner on one side and then it's full on the other, definitely have to go to a lip filler to be able to correct that.
28:51
SPEAKER_00: But there's a thing, as you know, called the Russian uh lip flip.
28:56
SPEAKER_00: And it appears when I see it done properly, that in from the front, unless someone wanted a lot of volume, it looks normal.
29:03
SPEAKER_00: But from the side, it's very distinctive.
29:05
SPEAKER_00: It almost looks like someone took fake lips and slapped them on your face because they protrude out so far.
29:10
SPEAKER_00: So, how do you feel about that?
29:12
SPEAKER_01: That's a technique.
29:13
SPEAKER_01: So, and a certain look.
29:14
SPEAKER_01: And I think it's personal.
29:16
SPEAKER_01: Some population like that look and they should be able to get it.
29:20
SPEAKER_01: So it's a very more distinct where it's bigger, is there's more volume, is a the technique is more of vertical injections where you yeah, so it's vertical.
29:31
SPEAKER_01: It comes from like the bottom of your lip and you do a ton of vertical injections and a ton of like just spreading out almost like the lips to give you that nice, distinct, and very crisp border.
29:42
SPEAKER_01: So it's just a technique.
29:43
SPEAKER_01: Like if you your clients are up to it, they get it.
29:46
SPEAKER_01: Um, I'm I don't personally want a Russian lip because it doesn't go with my ethnicity, but some faces go with it.
29:54
SPEAKER_01: Like there are women who have like big eyes who also want big lips.
29:58
SPEAKER_01: It looks great on them, but I think it's personal preference.
30:01
SPEAKER_00: I agree with that.
30:02
SPEAKER_00: I mean, uh for me, I love um being able to enhance natural beauty.
30:06
SPEAKER_00: So I'm very happy that duck lips went away.
30:09
SPEAKER_00: The really, really, really big ones.
30:12
SPEAKER_00: Yes.
30:13
SPEAKER_00: But um I understand what you're saying, and I agree with you.
30:16
SPEAKER_00: At the end of the day, it is your own body and your own face and make educated decisions and and keep it real that way.
30:22
SPEAKER_00: So when it comes to medical weight loss, um, let's talk about beyond the prescription.
30:26
SPEAKER_00: So GLP1s, we both know it's it's not just a trend, it's now a lifestyle.
30:32
SPEAKER_00: I think there are a lot of great reasons why a patient would opt in for a GLP1.
30:38
SPEAKER_00: It's not just about obesity.
30:40
SPEAKER_00: We're finding out that semi-glutides in particular, more so than trzepatide, is a deterrent to drinking or over-drinking.
30:47
SPEAKER_00: So for alcoholism, it's uh being reviewed now for one of the potential therapies.
30:54
SPEAKER_00: But we also see, in particular, like on our coastal cities, uh a lot of prescribers that have patients losing weight very rapidly, uh, far too rapidly.
31:04
SPEAKER_00: They put them on super high doses right away and keep them on high doses, don't seem to be checking in with their patients on a reality basis.
31:11
SPEAKER_00: And those are the patients that are walking around with osempic across, osempic face.
31:15
SPEAKER_00: We're even hearing now about osempic vulva and osempic scrotum.
31:19
SPEAKER_00: And it just comes down to having like that anorexia type of effect where your skin is just hanging off.
31:25
SPEAKER_00: So um, the prescriptions are not just a singular treatment plan.
31:30
SPEAKER_00: When it comes to GLP1s, how do you handle them?
31:33
SPEAKER_00: And how do you handle the new patients coming in asking for them?
31:37
SPEAKER_01: Again, another great topic, as it is almost like a trend now.
31:40
SPEAKER_01: You open your social media, is the talk.
31:44
SPEAKER_01: And I think that we have to be responsible again as providers, where it's not just about profit.
31:50
SPEAKER_01: It has to be the health, it has to be the overall wellness of your patient.
31:57
SPEAKER_01: So in our spa again, but we have a very thorough, very thorough um steps to get you to that medication.
32:05
SPEAKER_01: So you don't get your shots for your first day.
32:09
SPEAKER_00: Nice.
32:09
SPEAKER_00: That's really fun.
32:10
SPEAKER_00: That's amazing because most providers will give you everything you need on that first day.
32:16
SPEAKER_01: Again, that's not responsible.
32:18
SPEAKER_01: So we do a thorough history taking, just like any other uh things that we do in the office, could be aesthetics, mental.
32:24
SPEAKER_01: So we do a thorough um assessment, history taking, and again, you have to have a baseline lab.
32:30
SPEAKER_01: It's like you have to consider their like levels.
32:35
SPEAKER_01: Are they even a candidate?
32:36
SPEAKER_01: If they have like liver dysfunction, like that's something that you can't just put anybody on GLP1.
32:43
SPEAKER_01: So you have to be careful with that because then when we start people on GLP1, we also want you to get like a uh constant lab work to make sure you haven't deviated from your baseline, because then you might have to step back.
32:59
SPEAKER_01: So, as far as dosing, you always, always, always have to start on a very low dose.
33:05
SPEAKER_01: That's just the safest way to do it.
33:07
SPEAKER_01: I actually have we actually have a client who just stayed on the low dose these like past two years because it worked for her.
33:13
SPEAKER_01: So it's not just about giving everybody a shot.
33:17
SPEAKER_01: You have to look at the full picture.
33:20
SPEAKER_01: What is your life lifestyle?
33:23
SPEAKER_01: Like what is your plan, like your dietary uh plan when you start on this?
33:29
SPEAKER_01: Is this this is something that you can't just lean upon as your weight loss program?
33:35
SPEAKER_01: You have to be like a quick fix.
33:37
SPEAKER_01: Yes.
33:38
SPEAKER_01: You have to do um what what is your exercise habits?
33:42
SPEAKER_01: Like all of that play into play, uh come into place.
33:46
SPEAKER_01: And as part of the program, it's not just like a one-time thing.
33:51
SPEAKER_01: It's almost like a horizontal plan where we start here, we end there.
33:56
SPEAKER_01: It's it's a process.
33:58
SPEAKER_01: So we talk about dietary um uh plans, we talk about uh lifestyle changes, exercise, and then what's GLP1 in your weight loss overall weight loss program?
34:12
SPEAKER_01: Putting somebody on a high dose is just not responsible.
34:15
SPEAKER_01: It's not really how you do it.
34:16
SPEAKER_01: It's like off-protocol.
34:18
SPEAKER_01: And the the more dosing you give, especially the first few visits, you just have more side effects.
34:26
SPEAKER_01: And like people are not compliant with it because of the side effects.
34:30
SPEAKER_01: If you go slow, they are able to tolerate it better.
34:35
SPEAKER_00: Absolutely.
34:35
SPEAKER_00: So when we're not just talking about the the skin laxity issue with exempt face and exempt body parts, but um, as you just mentioned, and thank you for bringing that up, the side effects that are quite common either end of the spectrum, so constipation or diarrhea, and tell us about some of the other side effects that can happen.
34:54
SPEAKER_01: Nausea and vomiting is one thing, there's reflux issues, bloating.
34:59
SPEAKER_01: Um, some patients will have headaches.
35:02
SPEAKER_01: And you could really minimize that by using a low dose.
35:07
SPEAKER_01: You can even like see how they do with like the starting dose.
35:12
SPEAKER_01: If they have uh symptoms, you can actually like step back and give them half the dose.
35:17
SPEAKER_01: And most of the time, there's probably less than one percent who have issues if you just do it right.
35:24
SPEAKER_01: There's no rush to getting there, you it's not necessary.
35:29
SPEAKER_01: And I don't think you can get to like that proper outcome without like following like the right steps.
35:37
SPEAKER_00: Oh, absolutely.
35:38
SPEAKER_00: I applaud that also because I've seen the good effects in patients that were treated by providers like your establishment with your mentality, with you don't have to bombard a patient, you don't want to lose weight so quickly.
35:53
SPEAKER_00: There's a method to this madness, and then it'll be safe.
35:56
SPEAKER_00: And these are patients when they're led down the road properly, they're not having side effects at all.
36:01
SPEAKER_00: So exactly.
36:02
SPEAKER_01: I think it's great when it's used properly.
36:04
SPEAKER_01: And you have to also like start the conversation of expectations.
36:07
SPEAKER_01: What does it do to you physically?
36:09
SPEAKER_01: So you talk about skin laxity, like fat loss.
36:11
SPEAKER_01: Like that's your goal, right?
36:13
SPEAKER_01: You're gonna lose fat.
36:14
SPEAKER_01: Therefore, this is what's gonna happen to you.
36:16
SPEAKER_01: You don't want them to come back in a year later.
36:18
SPEAKER_01: It's like, oh my God, what happened to my skin?
36:20
SPEAKER_01: You never mentioned this.
36:21
SPEAKER_01: I have all this skin hanging now.
36:24
SPEAKER_01: So conversation starts in consultation.
36:27
SPEAKER_00: Well, these are amazing pearls of wisdom.
36:30
SPEAKER_00: And I hope that uh the potential providers, the providers that are already out there and the patients, all the viewers themselves, I hope everybody's taking notes because your advice, this is this is spot on.
36:42
SPEAKER_00: And I've heard a lot of advice from many professionals over the years.
36:46
SPEAKER_00: And as you know, as an educator and as a professor and every and all of your other wonderful uh expertise, that it's not always great advice.
36:57
SPEAKER_00: So when someone like yourself is giving advice, like I said, all the viewers out there, I hope you're taking notes.
37:02
SPEAKER_00: As a national trainer, I know one of the big companies, one of the huge companies that you train for is in mode.
37:09
SPEAKER_00: Yes.
37:10
SPEAKER_00: And we both know that there's been a lot of turmoil within the industry, and especially from patients, because they don't know uh what's going on with this FDA warning that came out in 2025 against uh RF microneedling, which means radio frequency microneedling combination for those that don't know what it is.
37:30
SPEAKER_00: And a big target without the FDA naming in mode and Morpheus 8, that is the most famous RF microneedle.
37:40
SPEAKER_00: And I feel like it definitely put a target on your back.
37:44
SPEAKER_00: So, as such a responsible uh provider and educator yourself, can you just tell us um, okay, yes, there can be major issues with RF microneedling, but here's why you shouldn't just be ready to crucify the entire industry.
38:00
SPEAKER_01: I definitely agree, and I'm thankful that you bring that up because if you can go online and read about the pros and cons and like how scary it can be.
38:09
SPEAKER_01: But I say, Morpheus is a very powerful device.
38:14
SPEAKER_01: It does its thing, it is great engineering for skin tightening and fat debulking, but in the wrong hands, it can be a disaster.
38:25
SPEAKER_01: So when they say, Oh my god, I'm not gonna do Morpheus, because like I saw online, they lost a lot of fat in their face.
38:32
SPEAKER_01: Guess what?
38:32
SPEAKER_01: You didn't do it right.
38:34
SPEAKER_01: So you you have to be trained well, you have to know how to use the device, and you can't really speak about the device if you haven't used it.
38:42
SPEAKER_01: Because me personally, I love the device.
38:45
SPEAKER_01: I have four of them because it works well.
38:48
SPEAKER_01: It it delivers what they say it can deliver only when done right.
38:54
SPEAKER_01: So the device itself says it can tighten the skin, it can debulk fat.
39:00
SPEAKER_01: Really, it can debulk fat because that's the layer of the of like um the skin that you're treating.
39:08
SPEAKER_01: If you go into the adipose tissue and the fat cells, you can really like blast energy and cause apoptosis and shrinkage of that area.
39:16
SPEAKER_01: So when you do fat debulking in areas where there's not a lot of fat, guess what?
39:23
SPEAKER_01: You're gonna lose the fat.
39:24
SPEAKER_01: You can have sunken face.
39:26
SPEAKER_01: So use it the right way.
39:29
SPEAKER_01: If you have fat tissue, especially like the areas in your jowls, supplementum, that's where you remove fat.
39:37
SPEAKER_01: Everything else, you use a skin tightening setting, and everything's gonna be okay.
39:41
SPEAKER_01: I've treated hundreds of patients with this.
39:44
SPEAKER_01: I have no issues at all.
39:46
SPEAKER_01: And I think, again, in the right hands, it could be a powerful device and it deliver a great outcome.
39:51
SPEAKER_01: In the wrong hands, it's a it's a disaster.
39:54
SPEAKER_00: You're absolutely correct, Elaine, that it's like driving a car.
39:58
SPEAKER_00: Not everyone has the right education and the right mindset to be behind a wheel.
40:02
SPEAKER_00: It's supposed to be a privilege, not a right.
40:04
SPEAKER_00: Not everyone should be driving a car.
40:06
SPEAKER_00: And not every provider knows exactly what they should be doing.
40:10
SPEAKER_00: And unfortunately, um, I've seen it myself where providers get excited and they're like, more is more, more means more.
40:16
SPEAKER_00: I'm gonna get, I'm gonna be the best at this in my entire region, and everybody's gonna only come to me.
40:22
SPEAKER_00: And then they go off of their training and they go off of the manual settings and they start readjusting settings and not really, as you said, evaluating the patient properly, and they just go wild on this person's face, and then there's all these detrimental side effects.
40:40
SPEAKER_00: So instead of understanding that it's an industry problem that we need to police on an individual basis and also continue to push our continuing education, it's like, oh, now there's this warning, now there's this panic, and now everybody hates RF micronealing.
40:54
SPEAKER_00: Education, that's a key.
40:56
SPEAKER_00: Absolutely.
40:56
SPEAKER_00: It's it's about education.
40:58
SPEAKER_00: As you said, patients should be self-educated and try as best as they can to cut out the noise and just stick to facts.
41:04
SPEAKER_00: Like, okay, I need to know these three facts about this thing, and now I'm going to go to a provider that I research, the best provider I can find that I can afford in my area.
41:13
SPEAKER_00: And I'm going to take those three questions there.
41:14
SPEAKER_00: And now we're going to continue to unpack all of this information so I can make an educated decision after I've been evaluated by this provider, see what they tell me, see how I feel about it, and then decide to move forward.
41:27
SPEAKER_00: Absolutely.
41:28
SPEAKER_00: I agree.
41:29
SPEAKER_00: So that also brings me up when it comes to modalities about talking about um somersell, radio frequency microneedling, laser, ultrasound, and IPL, they're all heat-based modalities.
41:40
SPEAKER_00: And you and I both know heat-based modalities have a place, whether it's to uh try to lift and tighten, or if it's trying to even out rough surface, there is a place to be able to put these into practice.
41:55
SPEAKER_00: Not every patient is going to be able to receive these treatments for many different reasons, from skin color to health conditions, to sun activities, uh, and also budget.
42:07
SPEAKER_00: But uh with Soma Cell, it's the first time in the US we have something that's reparative and regenerative.
42:14
SPEAKER_00: And that's proven going back with the technology to the year 2000.
42:18
SPEAKER_00: So that means, yeah.
42:19
SPEAKER_00: So that means we can lift and tighten uh the from the connective tissue, and then there's a radial effect up through the skin surface.
42:26
SPEAKER_00: So you're working on things like repairing elastin and creating new elastin and uh stimulating somatic stem cell release, which also helps to release exosomes.
42:37
SPEAKER_00: And then all of this is interacting on a cellular basis to rebuild collagen and to help stimulate a little bit faster acceleration of that collagen.
42:46
SPEAKER_01: So just like I'm fascinated to know that there's something out there.
42:50
SPEAKER_01: Like I've worked in the industry for years, and there's always these different modalities.
42:55
SPEAKER_01: And when I heard about somacell, I was like, what is this?
42:58
SPEAKER_01: And you know me, I dig into it, and I think it's very interesting that it goes straight into your fibroblasts, like there's biochemical like changes because, like, okay, so what I always ask, like, but the physiology of things, right?
43:11
SPEAKER_01: Because I need to understand why it is gonna tighten your skin, because there's all you need that collagen and elastic and all that.
43:18
SPEAKER_01: So if there's no heat, what kind of trauma that this machine does?
43:23
SPEAKER_01: So it's interesting to me that the mechanical like part of it just brings in that that biochemical like changes, therefore, you have this remodeling right in your connective tissue fibroblast.
43:38
SPEAKER_01: And I think that's really interesting.
43:40
SPEAKER_01: Now I'm really curious about it.
43:41
SPEAKER_00: And if any viewers are interested, you could check us out on the website at somacellskin.com.
43:47
SPEAKER_00: Social media, all the social media handles are at Soma Cell Skin, or you could drop us an email, contact at somacellskin.com.
43:55
SPEAKER_00: But Elaine, it's been such an eye-opener.
43:58
SPEAKER_00: I'm so honored, honestly, to have had you take this time out of your day today because you're so amazing, not just as a provider, not just as an educator, but as a woman out in the industry.
44:10
SPEAKER_00: You know, you keep pushing, you're grinding, you're putting out the right messages, you're bringing up the next generations, you're ironing out the issues with existing generations of providers, and you're just giving so much hope.
44:23
SPEAKER_00: Like that's the message I'm reading.
44:24
SPEAKER_00: Like, you're giving so much hope, I think, to so many people out there that, like, yes, you can do it.
44:29
SPEAKER_00: And there is a good way to do it, there's a bad way to do it, but you can find people like Elaine that can teach you how to do it the right way.
44:36
SPEAKER_00: Thank you so much.
44:37
SPEAKER_00: You're welcome.
44:38
SPEAKER_00: No, thank you.
44:38
SPEAKER_00: So, Elaine, please, um, let's share one more time as we wrap up with the viewers.
44:42
SPEAKER_00: How do they get in touch with you?
44:44
SPEAKER_00: Where can they find you for services?
44:46
SPEAKER_00: Where can they find you for education?
44:48
SPEAKER_01: And what's your social media?
44:50
SPEAKER_01: We are in Beka, New York.
44:51
SPEAKER_01: Our medspa is Vivesh Med Spa.
44:54
SPEAKER_01: You can check our website at www.vivashmedspa.com.
45:00
SPEAKER_01: Our number is 845-907-3003.
45:06
SPEAKER_01: And we are in Instagram, Vivesh Med Spa, and also on Facebook.
45:11
SPEAKER_01: And we would love to just chat with you, ask us any questions.
45:14
SPEAKER_01: We have free consultation, and I look forward to um just sharing our knowledge.
45:21
SPEAKER_00: Amazing.
45:21
SPEAKER_00: Thank you again.
45:22
SPEAKER_00: I really appreciate it.
45:24
SPEAKER_00: And I would love to have you back on again as a guest in the future.
45:28
SPEAKER_01: Thank you, Kim.
45:28
SPEAKER_01: Have a great day.
45:29
SPEAKER_01: Thank you so much again.